When I first started conceiving people in terms of emotions and defenses many years ago, I made the same mistake Freud had, many years earlier.

I noticed that people who got better had expressed their emotions and assumed that there was something about the expression itself that helped them do that.

Of course, that idea is nonsense, though it has a firm and unfortunate hold among both the lay public and an undeservedly large segment of treatment professionals. Venting (catharsis) alone does not work and cannot work at changing anything or anybody. There is a great deal of evidence confirming as much.

However, I was stuck trying to write objectively, so my therapy notes continued to read “So-and-so expressed his sadness about his mother” or some such, and my supervisor kept criticizing me for those notes, reminding me that expression wasn’t important. Working through was important.

My question at the time was how we would be able to operationalize working through, or even define it. I was informed that working through was a mystical process that just happened when the situation was right. If an emotion was fully and properly worked through, it never returned. If the emotion returned, then it obviously hadn’t been worked through completely.

This did me less than no good. I understood that expression wasn’t enough but knew that it was part of the working through process. I also had no way to know whether something had been worked through except that something else didn’t happen, and we all know how difficult proving a negative is.

So maybe how we know that something has been worked through? is the wrong question. Instead, the right question might be how do we set up the conditions in which it can be worked through?

This moves us away from trying to prove negatives and into the realm of trying to explain what was formerly seen as being mystical.

That sounds like an impossible task, but actually it’s not all that bad. Science is full of discoveries and theories that have addressed what was formerly the purview of religion. That is, as people have found other ways of conceiving problems they have discovered ways to measure and quantify what was formerly mysterious.

Working through, in the Freudian thinking, had something to do with libido, which these conjectures won’t address, largely because it can’t be shown to exist in any meaningful way. Besides, these conjectures are based not on energy models but on affect and defense and on what can be demonstrated about each.

All emotion must be regulated. Regulation is such an intrinsic part of emotion that it always accompanies emotional arousal. Regulation is first learned in dyadic relationships with caregivers, as sort of a dance between exposure to strong affect, distraction, and re-exposure.

Memories of significant events are not unitary, but instead are mediated by different parts of the brain. The emotional parts of the memory are mediated by one part while the contextual parts of it are mediated by another. As stress increases, the emotional parts get stronger and the contextual parts grow weaker.

Trauma occurs any time emotion outstrips the ability to regulate it productively, generally because of a breakdown of the dyadic relationship required to regulate it productively. This could happen for many reasons. Maybe the caregiver was the responsible party. Maybe the caregiver was unavailable.

In such situations, because of the way our stress systems are constructed, emotional memory far outweighs contextual memory. We are stuck with strong, unregulated emotions that occur without adequate contextual cues.

Without contextual anchors, the person cannot understand what the emotion means, how it originated, or where it came from. The sufferer may try all sorts of wild behavioral tactics to make it go away. They may feel driven to do all sorts of things inexplicable even to themselves.

A common strategy is attempting to avoid the painful emotion, which makes matters even worse. The degree of personality warp is directly proportional both to the intensity of the traumatic emotion and the intensity of its avoidance.

The process of working through begins when avoidance ends. The counselor assumes the role of caregiver and helps the client explore, express, and regulate the intense emotion. As the emotion is explored, its origin in the client’s life is explored. Context is reestablished.

By exploring the emotion, its intensity is allowed to decrease, allowing context to emerge. By reestablishing context, the emotional memory is brought back under individual control. Similar situations no longer provoke disproportionate responses.

This process leads to a marked decrease in objectionable and wildly emotional behavior that appears “out of touch” with ongoing events.

It leads to working through.

Writing for Twitter is a lot like writing bumper stickers because it demands clarity using very few words.  Evocative language helps. Tweeting demands mental discipline, and I like it.

My mind tends to edit too far, though, skipping steps others don’t always find intuitive. That has led to two recent questions about tweets I posted on my twitter account.

The first came separately from Alannah and Donna, who each asked me to explain what I meant by this:

Clients often must “cure” their therapists before the real treatment can begin.

Thanks for the question. There are different aspects to this. First, even good therapists with lots of experience (and prior therapy) can have blind spots. Maybe their own therapists had blind spots and certain aspects of the therapist’s character were not addressed.

Second, part of the problem with life generally (and therapy particularly) is that the words we use to describe it do not always model it very well. Yet, we all tend to carry these verbal models of reality around with us, acting like they indicate what’s really going on instead of being imprecise replicas.

Once we have two (or more) people communicating, we get into problems with shared meanings. If you say “tree” then I generally know what you’re talking about. If you say “anger” I may be unsure. If you say “controlling” I’d better check.

The problem comes in when you say something and I think I understand what you’re saying when I really don’t. If you are a therapy client, that’s not your problem, though it keeps you from getting your problem solved in a timely manner. This is especially true if the misunderstanding is at a key juncture in your larger model of the world.

If I think I know what you’re talking about and don’t, I may keep trying to take you down the wrong track.

Now, if I have blind spots because I have had a particular set of experiences that I model a certain way, and think that what you’re saying corresponds to my understandings because you use similar words (or at least words that evoke my models), we can waste a lot of time or worse.

If I think I understand you (when I don’t) and you don’t respond as I think you should, I’m apt to get frustrated with your lack of progress and may label you as “resistant.”

Again, this isn’t originally your problem, though you end up getting stuck with it.

What’s required before therapy can succeed is that I understand your models of the world, relationships, and yourself. To do this, I have to be open to different models and to idiosyncratic uses of common words.

I have to be open to the fact that the idiosyncratic models, word usage, and understanding may well be mine, not yours.

I have to become less certain, less defended, even less integrated. I have to put myself into a position of vulnerability, to become open again to growth in directions I may not expect and may have treated as settled for years.

There’s a line here. If I’m providing “counseling” or “therapy” to take advantage of my clients so I can get better on their dime, I’m victimizing them. I’m a fraud who should be put out of business.

On the other hand, if I’m providing “counseling” or “therapy” and am not willing to consider that my imperfect understanding of the client could be part of the current impasse, I’m a fraud who should be put out of business.

As in most things, the middle path is the correct one.

I hope this began answering the question, or at least stirred up some debate.

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The second question was from Susan, who asked about this tweet:

If you feel compelled to defend your emotion, it’s a defensive reaction, not a true feeling.

She asks, “What is not the true feeling, the original emotion or the defense of it? Think it is the original emotion, but wished to clarify.”

Again, thanks for asking, Susan. I have written about feelings before  (in case you missed that) which may help make that tweet make more sense. I recommend that as a starting spot for those who haven’t read it yet.

Now let me take the thought apart. Defensiveness always indicates the presence of anxiety (or possibly disgust, which seems to be pretty closely related to anxiety). Compulsion likewise indicates one of those. It’s generally thought to be an anxiety disorder, but research indicates that disgust is pretty connected much (or maybe most) of the time.

Anxiety (and most disgust, for that matter), is extremely cognitive. They are not what I call feelings. Anxiety in particular is a secondary emotion that is (practically) always a defensive reaction. (I put that in parentheses because I can’t think of a counterexample, though one may exist. I’m not denying the possibility, I just can’t think of an example.)

Anxiety has the property that it demands expression. Not expressing anxiety increases anxiety, while expressing it increases others’ anxiety. (Actually, not expressing it may also increase others’ anxiety.)

Now, compulsion about emotion is even trickier. Here is one key point: Feelings do not demand expression or defensiveness. Defensive secondary emotions do because they are grounded in and suffused with anxiety.

Any time you express something you’re not feeling or suppress something you are, anxiety will be present.

I really invite you to read through Emotions in Psychology and Psychotherapy, where I explain of science of this in much more detail. (If you want an ebook personalized, you can even request a Kindlegraph.)

The facility where I work has been given a difficult task—take adolescent males convicted of violent crimes and turn them into productive citizens. With many, we succeed. With others, we fail to reach the youth.

A third group sits in the middle, changing somewhat but never approaching what anyone would hope for them. That group’s success will ultimately depend on whether good enough parole plans can be devised for them that they can engage productively in society while others supervise them heavily, especially at first.

As we all know, there are linear ways of thinking that some people and professions use almost exclusively. The law is extremely linear. Engineering is pretty linear. Education is very linear.

Emotions are nonlinear. Relationships are nonlinear. Many people operate in an extremely nonlinear manner, so I’ve always found that most treatment approaches need to be.

Sometimes, linear treatment approaches work, but when they don’t the therapist had better have something else to bring or treatment is going to grind to a halt pretty quickly and potentially spin out of control soon afterwards.

I believe in outcome measures. I also realize that pursuing desired outcomes directly is not the same as having an effective and integrated treatment plan. The pursuit of happiness is not the same as being happy, after all.

Reading skills, for example, have been repeatedly correlated with reduced risk of reoffending. However, focusing on improving reading skills without focusing on changing antisocial values will only increase the numbers of adult prisoners with adequate reading skills. That doesn’t do society much good.

The Thought For the Day

Every day at work, one of the clerks sends out a thought for the day. I guess they are supposed to motivate and inspire us, to remind us why we are doing such difficult jobs. Generally, they are pretty innocuous. This is an example of one of those:

Too often we under estimate the power of a touch, a smile, a kind word, a listening ear, an honest compliment, or the smallest act of caring, all of which have the potential to turn a life around.

Sometimes though, they seem misguided or simplistic. A couple of weeks ago, this came out.

If you want trust, trust others. If you want respect, respect others. If you want help, help others. If you want love and peace in your life, give them away. If you want great friends, be one. That’s how it works.

That inspired me to write these thoughts. They’re longer, but in my experience much more accurate.

If you want trust, figure out who’s trustworthy and trust them. They’ll reciprocate. Don’t waste your time on people who won’t or can’t. One of the major developmental tasks many people fail at is figuring out who not to trust.

If you want respect, then respect people who have earned it and won’t abuse it. If you do respectable things, they’ll reciprocate. If you expect respect from people without self-respect, you’re more messed up than they are.

If you want help, ask helpful people for it. That usually works, but realize that helpful people are more likely to assist you if you pitch in and you’re not seen as a narcissistic and greedy SOB who just takes and takes and is only in it for yourself.

If you want love and peace in your life, look around you. They’re everywhere. Quit trying to force unloving people without inner peace to become loving and peaceful unless you just can’t live without added melodrama in your life. Again, learn who not to trust and in what circumstances your expectations may be part of the problem. If you set people up to do what they can’t do, you’re part of the problem.

If you want great friends, choose them wisely and cultivate your relationships with them. Don’t take them for granted. Be a good companion. Actively do things to help the relationship grow. Show them you care by doing small but meaningful favors along the way. These can be as small as listening for a few minutes after a hard day.

That’s how it works.

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Treating everything as linear while neglecting the nonlinear emotional/relational aspects of life is a lot of why treatment approaches get into trouble. It goes far deeper than simpleminded thoughts for the day, but those are sometimes symptomatic.

As I read through Emotions in Psychology and Psychotherapy one final time recently looking for last minute typos before it finally went public, I realized that although I hinted at it a couple of times in that book I never came out and stated my treatment philosophy directly. (Actually, I realized when writing the book that it was getting so long already that I should save that discussion for another book. After reflection I wasn’t completely certain I’d made the right decision.) Let me take this opportunity to briefly outline my philosophy.

My basic assumption almost from the start of my investigations has been that people could be divided into two major parts: genuine affect and defenses. I have seen nothing in almost 30 years to contradict that idea. Let me explain it more clearly.

What I’m calling genuine affect can be divided into two categories: feelings and bypassed emotions. Both are defined and explained in the book, and I’ve written about feelings on this blog before.

In the concepts used and explained within the book, feelings are schematically activated emotional reactions processed bottom-up and typically at an unconscious, subcortical level. They become conscious later in the process, though sometimes the thoughts associated with them become conscious and the affect itself never does. If any of that doesn’t make  sense, the book will help. It’s not that difficult, but there are lots of layers required to define feelings without including other affective entities.

Depending on your point of view and the verbiage you use to describe your beliefs, feelings are the voice of our good sense/unconscious wisdom or the way we connect spiritually to our core/higher power/creator. Whichever of these you believe, feelings are a good thing, though not always pleasant.

Bypassed emotions are those emotions that were never processed because at the time they originally arose (sometimes as feelings, but not always) they were considered too threatening and nobody appropriate could be found to help regulate them productively. In practice, they are often bypassed because the very attachment figures to whom one would be most likely to turn perpetrated the incidents that caused the intense emotional pain, though this is by no means necessary for an emotion to be bypassed.

Defenses in this system comprise much more than the familiar lists first devised by Anna Freud—denial, projection, introjection, repression, and so on. Defenses are anything used to avoid experiencing the bypassed emotion. The mechanisms on her lists do that, but so does behavior, personality, and much (or most) of what we call emotion, which is either defensively activated through cortical involvement or the results of ploys to meet particular ends that have been reinforced so many times that they have become automatic. This is also explained much more fully in Emotions in Psychology and Psychotherapy.

By guarding against experiencing bypassed emotion, defenses also prevent feelings from being recognized and responded to. If you won’t learn from your rawest emotional experiences, you can’t learn from your good sense, either.

Symptoms actually bridge affect and defense, since they are compromises between bypassed emotions and defenses. Each plays a role I determining what symptoms will develop and how they will operate. Blocking the expression of symptoms invariably brings the bypassed emotion closer to the surface. That is one necessary step in therapy, though not the first one.

Most counselors and psychotherapists treat defenses. They treat the symptoms, behavior, relationship patterns, or personality, at least initially. This isn’t their fault—it’s how they were taught and how most treatment is conceived, whether the treatment is CBT, gestalt therapy, pharmacotherapy, systems therapy, or psychoanalysis. I think those models are in error.

Most providers treat their clients’ depression, hostility, anxiety, lying, compulsive behavior, poor relationships, narcissistic personalities, and so forth. In my opinion, this approach is needlessly slow and inefficient because it does not see the issue clearly.

None of those defenses would exist if the person were not trying to avoid experiencing some sort of traumatic (or semi-traumatic) emotional pain. When the bypassed emotions are resolved, the misconduct, compulsive behavior, relationship woes, and disordered personality have no reason for further existence and they become much more amenable to change. In practice, they often start changing on their own once the underlying reasons for their existence have been addressed.

I recently wrote a post about narcissism that got several good responses from interested readers wanting to add a point or two about how narcissists usually present. Those comments were correct, but in this scheme they are beside the point. I would only care about the intrapsychic and behavioral mechanisms involved in narcissism if I were interested in treating it directly, which I assuredly am not.

I have no interest in treating narcissism directly. Those are hardened defenses. The same goes for marital infidelity, criminally assaultive behavior, and any number of other serious and often intractable problems.

Rather than fighting through defenses to get at the core, I would much rather skip past them and change the person from the inside.

Your preferred theory may say that doing that isn’t possible or preferable, or that if you don’t confront the defenses along the way the changes made cannot be real and lasting, but I’m here to tell you that your preferred theory is mistaken.

This week, I sat in a room full of coaches and entrepreneurs dedicated to changing the world. While all of them wanted to earn a good living, each of them was dedicated to bettering the condition of the planet and people on it.

One wanted to help women find suitable mates. One wanted to help small businesses get control of their accounting processes. A couple of them wanted to help people learn to speak confidently in public so they could get their messages out more effectively. A couple of others wanted to help people define their messages so they could attract the clients they work with most effectively to their businesses. One wanted to help plus-sized women learn to value themselves. One wanted to help people with panic disorders handle life more effectively and another wanted to do the same for adults with ADHD.

What struck me about this was the number of former therapists in the crowd. I met at least two former social workers, two former drug and alcohol counselors, a former mental health counselor, and a former family therapist. There may have been others, I just didn’t ask. Each of the former mental health professionals had many years’ service in mental health. All of them were now coaching and selling their expertise. None were involved in mental health treatment any more.

I read a joke recently that said the main difference between a therapist and a coach was an extra “0” at the end of their yearly income. I don’t begrudge anyone money. Everyone should get paid what they’re worth, should be able to support their families, and should be able to take vacations or get sick without worrying they won’t be able to pay their mortgage.  Everybody deserves a chance to grow out of a career that no longer fits them and into one that does. I have no problems with any of that.

What I have problems with are the reasons I was told about their leaving, which all centered on the industry, not the clients. People who felt they were forced to trade hard hours for minimal dollars. People who had been on the same insurance panels for over 20 years whose rates had been lowered. People who had well-developed practice niches who were being reimbursed at the same rates as someone with a general practice who had just completed their internship and been licensed that month. In short, they were people who had grown tired of being treated as commodities by the insurance industry and saw no way of escaping that.

While I have no problems with people making money or changing careers, I have definite problems with good and dedicated people being forced from the market. Mental health counseling is not an easy profession. Like anything else, it takes years of dedicated practice to develop expertise, and even then it is likely to be in a limited area. Those with 20 or more years of experience should be the leaders and elders of the group, not the castoffs who are forced to change careers to make sure their retirement years are not spent in poverty.

Something is very wrong with this model of “care.” I know what at least part of my solution would be, but right now I’m much more interested in hearing about yours. If you’re a mental health professional or have ever worked with one (or considered working with one), I’d really like you to comment below. What would be the best first steps to take to save our profession? Or, should it be saved? Am I overreacting? Please give me a reality check here. I honestly need your help.

Venting doesn’t work.

There. I’ve said it.

People won’t quit trying to give me their differing opinions about this. “Well, I think you’re wrong, Dr. Brownlow. I vent and I use venting with my clients all the time and I feel that it does work.”

Do I need to say it again?

Venting is one of those ideas that just won’t go away. We all know that people feel better when they express themselves, right? And we know that emotions get blocked up and cause problems when they aren’t allowed free expression, right?

Well, no, not exactly. That first part seems to be true, especially with anger. People report feeling better once they have let off steam. I feel better once I’ve let off steam. You probably feel better once you’ve let off steam, unless you’re conflicted about getting angry. The problem is that letting off steam does nothing to relieve the anger, and if it’s really rage or hostility instead of anger, expressing it actually makes the rage or hostility more likely to appear in the future, not less. There’s good research on this.

How about blockages? Don’t emotions need free expression to keep them from being blocked? Shouldn’t we “get it out?”

Actually, this was one of Sigmund Freud’s most misguided ideas. Regular readers to this blog know that I admire a lot of Freud’s ideas. However, we neglect the brilliant stuff he wrote about unconscious processing, transference phenomena, and symptom formation, but we stick with a model of emotions that even Freud acknowledged was not workable.  This is lunacy.

Let’s start at the beginning. Working through an emotion requires several steps. First, it must be accepted at a deep level. It must be experienced fully within the body and acknowledged. Avoiding it, muting it, or amplifying it creates additional problems if they continue. If it must be muted temporarily so some important task can be completed, that’s OK—just get back to it when you can, and do it fully when you are able.

Second, the emotion must be labeled, the more accurately the better. Labeling an emotion means that it’s not the unbearable pain in the chest anymore that you avoid because you think it’s going to kill you. It’s sorrow, or shame, or whatever. Labeling emotions establishes control over them. This is the first step towards regulating emotions productively, but only works properly if the first stage has been done fully.

Third, the emotion must be regulated. This is where expression comes into play. Plenty of good research evidence shows that expressing emotions helps, but only under certain conditions. Muttering to yourself may help a little—this hasn’t been studied, to my knowledge. Writing without sharing the contents helps a little, but not much. Writing about your deepest darkest trauma helps relieve it if you share the writing with someone, even if they never acknowledge reading what you wrote.

What helps is real, empathic, dyadic communication. Expressing yourself so others will know that you’ve been done wrong doesn’t help. Going into rages doesn’t help. Beating a punching bag doesn’t help. Sobbing wildly doesn’t help, and may lead to the kinds of dysregulation apparent in chronic depression. Crying helps regulate most people, but not those who are clinically depressed. Their system no longer corrects itself automatically.

Talking about your deepest emotional pain to someone who doesn’t show that they care can be traumatizing. How many little kids have told their parent about being sexually abused, only to be brushed aside? We all know that this is true—there’s nothing magical about talking, per se.

Express your emotions in a heartfelt manner to someone who is empathic and has your best interests in mind. That helps. Small children learn to regulate their difficult emotions through dyadic arrangements like this all of the time before they learn to do it on their own, and do so periodically thereafter. Grownups sometimes need the same consideration.

Expressing yourself in this way helps you acknowledge the emotion fully, identify it, bear it, and find ways to regulate it productively while still doing so. It helps you translate what the emotional pain was trying to communicate into thoughts that can be understood, communicated, and integrated into your life narrative. It helps you discover the action tendency the emotion was communicating and decide whether you want to follow through with the action. It helps you determine how the emotional experience has impacted your belief system. It helps you put the entire experience into a wider perspective.

That’s what helps. That’s why people pay to see counselors. That’s what good therapy does. Yelling at people in other cars doesn’t do that. Beating on pillows doesn’t do that. If expressing the emotion is done well in the correct circumstances, it can be transformational. If either isn’t true, it can be devastating.

There’s nothing magic about expressing an emotion if it isn’t done right. Venting doesn’t help anything, whether you believe it does or not.

Do I need to say it again?

A couple of months back, I entered a discussion on a LinkedIn board about how best to help some young kids. Their situation was all too common—mom and dad were fighting one another as part of a divorce/custody battle and the kids were caught in the middle.

Again, as happens all too often, the dad kept making promises to his kids that he didn’t keep. He had money and good attorneys, and kept winning rights for visitation he never used, though he kept saying he would. The kids were saying they didn’t want to visit him but were upset when he didn’t show up, time after time. The mom responded by trying to protect the kids from being hurt by the dad’s lack of reliability. Dad’s attorneys successfully painted the mom as obstructing court orders and the therapist as being in the mom’s pocket.

This wasn’t big news. Unfortunately, we’ve probably all seen too many families like that, both personally and professionally.

What made the case more difficult, complex, and (maybe perversely) interesting to me was that the dad, by all accounts, displayed lots of psychopathic tendencies. The discussion predictably focused on how awful the dad was, how disordered he was, and how poorly the courts seemed to be protecting his young children from what he represented.

The suggestions focused on advocating in court for the children by testifying about their father’s adverse effects on their growth (though this clearly had backfired when tried earlier) and helping distract the kids from how painful interacting with their dad was.

I took a different stance. I believe in changing what can be changed and adapting to what can’t. The dad couldn’t and apparently, neither could the judge. As long as the whole thing was going to be painful and drawn out, it was time for therapy to focus on minimizing the negative impact of the situation and maximizing the children’s growth.

Distraction only works for awhile. Eventually, people have to bear and regulate their emotional pain or they get stuck. They have to learn about relationships and regulate their social lives, too. It’s nicer when that happens in adolescence, but the timing is not something we control, either. Effective therapists deal with what is.

Considering that case, I came up with the following 10 points of emphasis for therapy with the children, which I offer for your consideration. I think they apply broadly.

•  As long as you are going through the emotional pain, make it worthwhile. That way, you won’t have to repeat the same pattern for the rest of your life while you struggle to grasp what you could be learning now.

• Other people’s behavior is about them. Your behavior is about you.

• Your parents may not be the people you wish they could be. Nobody’s are, including my children’s. That’s sad, but it’s a lesson for everybody about all relationships.

• Even if you love someone, they may not love you back the way you want them to, and they might not love you back at all.

• Most people are pretty trustworthy most of the time, but some aren’t. Learn to spot the ones who aren’t and decide if you want to have relationships with them.

• Learn how to enter relationships and not believe at some level that they will recapitulate your relationships with your parents.

• Learn not to accuse falsely or trust unwisely.

• Understand what being done wrong feels like so that when you are tempted to do something wrong to someone else later, to lie to them, etc., you will have empathy for those people and know the pain you are causing.

• Learn that even in moments of extreme emotional pain, there are people interested in your wellbeing who care about you and will help you regulate your raw emotions.

• Realize that while you have no control over others’ behavior, you have total control over how you treat others. You can be better than they are.

As I said, it’s a lot for little kids, but chunked down to their levels it’s doable, and it’s all stuff that healthy adults need to master along the way. Focusing on how bad the dad is will not help–it’s a given. Focusing on asserting the kids’ control of their outlook and behavior will produce healthier people. To me, that’s the therapist’s job.

What do you think? What else should have been added, or was the entire focus completely off track?